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Speculation as to the causes of the recent mass shooting at a Batman movie screening in Colorado has reignited debates in the psychiatric community about media violence and its effects on human behavior.

“Violence in the media has been increasing and reaching proportions that are dangerous,” said Emanuel Tanay, MD, a retired Clinical Professor of Psychiatry at Wayne State University and a forensic psychiatrist for more than 50 years.

“You turn on the television, and violence is there. You go to a movie, and violence is there,” Tanay told Psychiatric Times. “Reality is distorted. If you live in a fictional world, then the fictional world becomes your reality.”

The average American watches nearly 5 hours of video each day, 98% of which is watched on a traditional television set, according to Nielsen Company. Nearly two-thirds of TV programs contain some physical violence. Most self-involving video games contain some violent content, even those for children.1

Tanay noted, “Anything that promotes something can be called propaganda.” What we call entertainment is really propaganda for violence. If you manufacture guns, you don’t need to advertise, because it is done by our entertainment industry.”

In reality, the number of violent crimes has been falling, but the public’s perception is that violence has increased. According to the US Bureau of Justice Statistics, the overall violent victimization rate (eg, rape and assaults) decreased by 40% from 2001 to 2010. Similarly, the murder rate in the US has dropped by almost half, from 9.8 per 100,000 people in 1991 to 5.0 in 2009.

Yet the propaganda, Tanay said, makes people feel that crime is everywhere and that guns are needed for protection.

Asked about the hundreds of murderers he has examined and possible links to media violence, Tanay said, “Most homicides are committed by people who know each other, and who have some momentary conflict and have a weapon handy. Usually only hit men, who are very rare, kill strangers.”

Tanay did acknowledge, however, that some mentally ill individuals are vulnerable to dramatized violence. “They are naturally more vulnerable, because they are in the community, they are sick, and they may misinterpret something.”

The 2 teenage boys who murdered 12 schoolmates and a teacher and injured 21 others at Columbine High School in Colorado before killing themselves, he said, lived in a pathological environment. “Their lives centered around violent video games.”

After the 1999 Columbine tragedy, the FBI and its team of psychiatrists and psychologists concluded that both perpetrators were mentally ill—Eric Harris was a psychopath and Dylan Klebold was depressive and suicidal. Other analysts have argued that a possible causal factor may relate to the young killers’ obsessions with violent imagery in video games and movies that led them to depersonalize their victims.

While the vast majority of individuals afflicted with a psychotic disorder do not commit violence, Tanay said, “some mass killings have been perpetrated by people who are psychotic.”

He cited the example of Seung-Hui Cho, a student who in 2007 shot to death 32 students and faculty of Virginia Tech, wounded 17 more, and then killed himself. “Cho was psychotic. Twenty years ago he would have been committed to a state hospital. . . . Now, we don’t take care of psychotic patients until they do something violent,” Tanay said.

Writing about the Colorado tragedy in a July 20 Time magazine essay, Christopher Ferguson, PhD, Interim Chair and Associate Professor of Psychology, Department of Psychology and Communication at Texas A&M International University, argued there is currently no scientific proof that the mass homicides can be explained, even in part, by violent entertainment.

Research studies

So what does research show?

A 2002 report by the US Secret Service and the US Department of Education, which examined 37 incidents of targeted school shootings and school attacks from 1974 to 2000 in this country, found that “over half of the attackers demonstrated some interest in violence through movies, video games, books, and other media.”2

In a 2009 Policy Statement on Media Violence, the American Academy of Pediatrics said, “Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed.”3

This year, the Media Violence Commission of the International Society for Research on Aggression (ISRA) in its report on media violence said, “Over the past 50 years, a large number of studies conducted around the world have shown that watching violent television, watching violent films, or playing violent video games increases the likelihood for aggressive behavior.”4

According to the commission, more than 15 meta-analyses have been published examining the links between media violence and aggression. Anderson and colleagues,5 for instance, published a comprehensive meta-analysis of violent video game effects and concluded that the “evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect and for decreased empathy and prosocial behavior.”

In a Psychiatric Times interview, psychologist Craig Anderson, PhD, Director of the Center for the Study of Violence at Iowa State University, said the evidence for the media violence–aggression link is very strong from every major type of study design: randomized experiments, cross-sectional correlation studies, and longitudinal studies.

In 2007, Anderson’s group reported on a longitudinal study of violent video games. The study queried children and their peers as well as teachers on aggressive behaviors and violent media consumption twice during a school year. The researchers found that boys and girls who played a lot of violent video games changed over the school year, becoming more aggressive.6

“There now are numerous longitudinal studies by several different research groups around the world, and they all find significant violent video game exposure effects,” Anderson said.

In contrast, a longitudinal study published this year by Ferguson and colleagues,7 which followed 165 boys and girls (aged 10 to 14 years) over 3 years, found no long-term link between violent video games and youth aggression or dating violence.

Studies from Japan, Singapore, Germany, Portugal, and the US show that “the association between media violence and aggression is similar across cultures,” according to Anderson.

“Most recently,” he added, “we found that within a high-risk population [incarcerated juvenile offenders], violent video games are associated with violent antisocial behavior, even after controlling for the robust influences of multiple correlates of juvenile delinquency and youth violence, most notably psychopathy.”8

There is growing evidence, Anderson said, that high exposure to fast-paced violent games can lead to changes in brain function when processing violent images, including dampening of emotional responses to violence and decreases in certain types of executive control. But there also is some evidence that the same type of fast-paced violent games can improve some types of spatial-visual skills, basically, ability to extract visual information from a computer screen.

One of many factors

Despite the links between media violence and aggression, Anderson stressed, “media violence is only one of many risk factors for later aggressive and violent behavior. Furthermore, extremely violent behavior never occurs when there is only one risk factor present. Thus, a healthy, well-adjusted person with few risk factors is not going to become a school-shooter just because they start playing a lot of violent video games or watching a lot of violent movies.”

One of Anderson’s colleagues at Iowa State University, Douglas Gentile, PhD, Associate Professor of Psychology, along with Brad Bushman, PhD, Professor of Communication and Psychology at Ohio State University and Professor of Communication Science at the VU University in Amsterdam, recently published a study that identifies media exposure as 1 of the 6 risk factors for predicting later aggression in 430 children (aged 7 to 11, grades 3 to 5) from Minnesota schools.9 Besides media violence, the remaining risk factors are bias toward hostility, low parental involvement, participant sex, physical victimization, and prior physical fights.

Knowing students’ risk for aggression can help school officials determine which students might be more likely to get in fights or possibly bully other students, according to Gentile, who runs the Media Research Lab at Iowa State University. He said he can get “over 80% accuracy” in predicting which child is at high risk for bullying behavior by knowing 3 things—“are they a boy, have they gotten in a fight within the past year, and do they consume a lot of media violence.”

In discussing their study findings, Gentile and Bushman wrote: “The best single predictor of future aggression in the sample of elementary schoolchildren was past aggression, followed by violent media exposure, followed by having been a victim of aggression.”

They added that their risk-factor approach can “cool down” the heated debate on the effects of media violence, since “exposure to violent media is not the only risk factor for aggression or even the most important risk factor, but it is one important risk factor.”

“We are interested in using this new approach to measuring the multiple risk factors for aggression in additional samples, and also increasing the number of risk factors we examine (there are over 100 known risk factors for aggression),” Gentile told Psychiatric Times. He and colleagues have several other studies under way in several countries.

“I am particularly hopeful that this approach will help the public and professionals realize that media violence is not different from other risk factors for aggression. It’s not the largest, nor the smallest,” he said. “If there is any important difference at all, it is simply that media violence is easier for parents to control than other risk factors, such as being bullied, having psychiatric illnesses, or living in poverty.”